When to Treat Hypertriglyceridemias

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The guidelines for use of drugs to treat familial hyper-triglyceridemia type IV are less well defined than those for hypercholesterolemia. One should account for plasma HDL in deciding to treat hypertriglyceridemias with the intent of decreasing the risk for CHD. Moderate hypertriglyceridemia (200-500 mg/dL) without low HDL may not be an independent risk factor for CHD. However, the results of a recent clinical trial indicate that hypertriglyceridemia is an independent risk factor for ischemic stroke. Results of the Helsinki Heart Study showed that the reduced risk of CHD with use of gemfibrozil (discussed later) was correlated with elevation of HDL plus reduction of VLDL triglyceride rather than reduction of LDL cholesterol. Gemfibrozil has little effect on plasma LDL.

Low HDL cholesterol (<35 mg/dL) is an independent risk factor for CHD. HDL appears to antagonize atherogenesis by at least two mechanisms. HDL can mobilize cholesterol from extrahepatic cells (such as arterial wall foam cells) and transport it to the liver for disposal (reverse cholesterol transport); HDL also has antioxidant properties. HDL contains the potent an-tioxidant enzyme paraoxonase, which may protect LDL lipids from oxidation. Thus, hypertriglyceridemia with

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